Pulse Check with Dean Nelson - April 2026
Sharing thoughts, laughs, and a little wisdom!
Before the Chart Opens
Before the chart opens, before a single lab result returns, something registers. A patient arrives, the room feels wrong, and your gut tells you he is sick. The first call – sick or not sick – shapes every decision that follows: the workup, the disposition, whether this patient goes home or stays. The assessment takes shape faster than language can follow. You act. Only later, reviewing what you did and why, do you reconstruct the reasoning behind a decision that felt more like recognition than analysis. Nobel laureate psychologist Daniel Kahneman calls this System 1: the fast, intuitive mind that runs beneath conscious thought.
In
Thinking, Fast and Slow
, Kahneman describes two distinct modes of thinking. System 1 operates automatically and rapidly — pattern recognition shaped by years of experience. System 2 is slow, deliberate, and effortful — the analytical mind that works through novel problems step by step. Neither system is superior. The art lies in knowing which to trust. As Kahneman observed, the confidence we feel in our intuitions is not always a reliable guide to their accuracy, which means expertise and humility must travel together.
I find myself navigating this interplay constantly in my own work. Leadership decisions that once required careful deliberation — how to read a profit-and-loss spreadsheet, how to present a vision to a donor, how to walk into a difficult conversation — increasingly flow from accumulated context. But I have also learned to recognize the moments that demand slowing down: the sticky interpersonal situation or the decision where the stakes make speed a liability rather than an asset.
The same dynamic appears throughout our college. A senior attending physician guiding a complex clinical scenario draws on decades of System 2 analysis compressed into System 1 recognition — a form of expertise that took years to build and cannot be shortcut. Our medical students, moving through their clinical rotations, begin with methodical, checklist-driven examination that gradually integrates into something faster and more fluid. Anders Ericsson's research on deliberate practice — popularized by Malcolm Gladwell in Outliers — suggests that genuine expertise requires 10,000 hours of sustained, intentional effort before pattern recognition becomes truly reliable. Artificial intelligence adds a new dimension to this conversation. It can produce outputs that resemble expert pattern recognition — but the value of that output depends entirely on whether the person receiving it has enough System 2 foundation to evaluate what they are looking at. What AI cannot manufacture is the foundation required to evaluate its own output.
When we invest in rigorous foundational training, we are constructing the System 2 infrastructure that eventually becomes expert intuition. When we create structures for deliberate reflection — such as case conferences and morbidity and mortality rounds — we calibrate that intuition, making it more reliable over time. When we build a culture that values both quick action and careful analysis, we prepare our graduates to navigate the full spectrum of clinical complexity.
Florida Atlantic is in the business of building both — the analytical foundation and the expert intuition that grows from it. A medical school that stops teaching its students when to use System 1 and System 2 does not produce skilled clinicians. It produces dangerous ones.
Pop Culture Reference: Drops of God (Apple TV+ series)
Drops of God — a Japanese manga series with an acclaimed live-action adaptation on Apple TV+ — follows the world of elite wine competition, where a single sip can separate a lifetime of deliberate practice from raw, unschooled intuition.
At the center of the story is a competition between two very different kinds of knowing. Issei Tomine has spent years in deliberate, methodical training — learning to analyze wine systematically before he ever trusted his instincts. Color, aroma, structure, and finish. Each step is earned through repetition. Camille Léger arrives with almost no formal preparation, guided instead by a remarkable natural gift: she experiences wine viscerally, intuitively, before analysis ever enters the picture. To an observer, both produce extraordinary assessments. But the process underneath could not be more different.
Kahneman would recognize them immediately. Issei is System 2 that has become System 1 — deliberate practice compressed, over thousands of hours, into reliable expert intuition. Camille is pure System 1, unanchored by the analytical foundation that makes intuition trustworthy under pressure. Her gift is real. But consider what unfolds when the wine is truly unfamiliar, when the stakes are highest, when instinct alone is not enough. That is the moment the training shows — or does not.
Medical education is in the business of producing Isseis. The goal is not to suppress instinct but to build the analytical foundation underneath it — so you know when to trust it, and when to question it.
Stay curious, MedOwls.